In 25 years as a counselor and 12 or so teaching college students, as well as being an interested observer of how American culture views addiction, treatment, and recovery, I am struck by what seems to be one of the biggest misconceptions that people have about treatment, namely that an individual must "want" help in order to be helped. My reaction to this perceived truism is a resounding"no!" The reality is that the desire to recover, the motivation to change, if you will, is most often something that develops during the course of counseling or treatment. Yes, ultimately the individual client or patient does need to want to change, to recover, but this desire is frequently very low or even non-existent at the commencement of treatment or counseling. All that is really required at the front end is some willingness to show up or participate--the professionals can take it from there.

Imagine if it were true that for treatment to be successful the individual must really want help. Here is a somewhat-over-the-top depiction of what an initial counseling exchange would look like:Counselor: How can I help you today?Client: Well, my drug use is really causing me a problem, so I called your treatment center for help, I know I need treatment, I cannot stop on my own, and I think you are the folks to help me, regardless of how much it might cost or how much work (or school) I might miss.I am not sure many of us who do this work have ever heard quite that sentence--and part of me wonders what we would do if we did. A much more common exchange would be something like:Counselor: What brings you here today?Client: I don't know. My family thinks I have a drug problem because I just got fired from my job for testing positive on a drug test, but it was just marijuana, which should be legal anyway, and I could stop any time I want. It's no big deal, and I don't need to be in this place with all these drug addicts, that's for sure.That gives us somewhere to start. In reality, it is very common for the desire to recover to be something that grows gradually during the course of treatment. In the language of motivational interviewing, clients frequently come to treatment in the precontemplation or contemplation stages, rather than in the action stage.Just a thought--thanks for letting me share with you.